Advertisements for Rezdiffra (resmetirom, Madrigal Pharmaceuticals Inc.), which was approved by the U.S. FDA in March 2024, adorned the lobby of The Liver Meeting 2024 being held at the San Diego Convention Center as well as the trolley stop across the street and other areas that doctors attending the meeting might be swayed. But inside the ballrooms of the convention center, companies were making presentations of data from clinical trials testing their drugs in patients with metabolic dysfunction-associated steatohepatitis (MASH) in hopes of potentially competing with Rezdiffra in a few years.

Patients infected with hepatitis C have had the ability to rid their livers of the virus for some time, while patients with chronic hepatitis B virus infection have been required to take medications for the rest of their lives in the hopes of just dampening damage to the liver caused by the virus. But, at The Liver Meeting 2024, Arbutus presented data from the phase IIa Im-prove study suggesting a cure might be on its way with its DNAi drug, which binds to the viral mRNA promoting its cutting, leading to loss of translation of the viral proteins.

Modern molecular techniques have progressed to the point where sequencing can seem almost quaint. At the Basic Science Symposium of the American Association for the Study of Liver Diseases 2022 meeting (AASLD 2022), new techniques were on full display, with sessions devoted to epigenetics, microbiome analysis and spatial transcriptomics. But the first session was still on genetic variants in all their forms – rare variants, common variants and nongermline mutations.

Modern molecular techniques have progressed to the point where sequencing can seem almost quaint. At the Basic Science Symposium of The Liver Meeting 2022, new techniques were on full display, with sessions devoted to epigenetics, microbiome analysis and spatial transcriptomics. But the first session was still on genetic variants in all their forms – rare variants, common variants and non-germline mutations.

High hopes rest on manipulating the gut microbiome in order to treat a multitude of disorders. Clinical validation for the idea has come from the success of fecal microbiome transplants to treat chronic Clostridium difficile infections. Such transplants are in clinical trials to treat other gastrointestinal disorders, and more targeted methods to manipulate the microbiome are being developed as well, not just for infections, but in a multitude of other indications. Targeting the gut microbiome may turn into a way to alleviate inflammatory bowel disease, food allergies, and even psychiatric conditions.

In contrast to most adult mammalian tissues, the liver can regenerate itself to an impressive degree. That regeneration is critical to survival – as a key digestive organ, the liver deals with all sorts of toxins, from rotten-ish food in the wild to alcohol in more cultured settings.